Norovirus infection primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


There is no vaccine to prevent norovirus infection. Prevention of foodborne norovirus disease is based on the provision of safe food and water. Noroviruses are relatively resistant to temperature changes and have been associated with illness after eating steamed shellfish. Moreover, noroviruses can survive in up to 10 ppm chlorine, well in excess of levels routinely present in public water systems. Despite these features, it is likely that relatively simple measures, such as correct handling of cold foods, strict hand washing after using the bathroom and before handling food items, and paid sick leave, may substantially reduce foodborne transmission of noroviruses. Prevention of norovirus disease spread via droplets from vomitus (person to person transmission) should focus on methods that limit transmission including: isolation precautions (e.g. isolating sick patients in a healthcare facility) and environmental disinfection.

Primary Prevention

  • Hand washing with soap and water is an effective method for reducing the transmission of norovirus pathogens.
  • Alcohol rubs (≥62% ethanol) may be used as an adjunct, but are less effective than hand-washing since norovirus lacks a lipid viral envelope
  • Surfaces where norovirus particles may be present can be sanitized with a solution of 1.5% to 7.5% of household bleach in water, or other disinfectant effective against norovirus[1][2][3]

Practice Proper Hand Hygiene

  • Wash your hands carefully with soap and water especially after using the toilet and changing diapers, and always before eating, preparing, or handling food. Alcohol-based solutions may be used as an adjunct to handwashing but not as a replacement to handwashing.
  • Noroviruses can be found in vomit or stool even among asymptomatic individuals.
  • Viral shedding in stools can remain up to approximately 2 weeks following resolution of symptoms.

How to Adequately Wash Hands

Hands must be washed accordingly:[5]

  • Wet hands with warm water
  • Apply a generous amount of soap
  • Rub hands together for at least 20 seconds
  • Rinse hands
  • Dry hands with a paper towel
  • Use the paper towel to turn off the faucet and open the door

Wash Fruits and Vegetables and Cook Seafood Thoroughly

Vegetables and cook seafood must be washed considering the following:[6]

  • Carefully wash fruits and vegetables before preparing and eating them
  • Cook oysters and other shellfish thoroughly before eating them. Be aware that noroviruses are relatively resistant to high temperatures. They can survive temperatures as high as 140°F; quick steaming processes that are often used for cooking shellfish
  • Food that might be contaminated with norovirus should not be ingested and should be thrown out
  • Keep sick infants and children out of areas where food is being handled and prepared
  • When you are sick, do not prepare food or care for others (even those who are also sick). You should not prepare food for others or provide care while you are sick and for at least 2 to 3 days after you recover. This also applies to sick workers in settings such as schools and daycares where they may expose people to norovirus

Clean and Disinfect Contaminated Surfaces

  • After throwing up or having diarrhea, immediately clean and disinfect contaminated surfaces
  • Use a chlorine bleach solution with a concentration of 1000–5000 ppm (5–25 tablespoons of household bleach [5.25%] per gallon of water) or other disinfectant registered as effective against norovirus by the Environmental Protection Agency (EPA). For more information, see the EPA’s registered antimicrobial products effective against norovirus [7]

Wash Laundry Thoroughly

  • Immediately remove and wash clothes or linens that may be contaminated with vomit or stool (feces).
  • Handle soiled items carefully without agitating them. Wear rubber or disposable gloves while handling soiled items and wash your hands immediately after glove removal/disposal.
  • Wash the items with detergent at the maximum available cycle length then machine dry them.

Detection in Foods

Preventing Norovirus Outbreaks on Cruise Ships

Recommendations For Passengers

  • Wash your hands often:[9]
    • Before eating, drinking, and smoking
    • After touching your face and after visiting bathroom
    • Whenever hands are dirty
  • Leave the area if you see someone get sick and report it to the staff if not done already
  • Keep yourself hydrated
  • If you are sick before the cruise, consider rescheduling
  • If you are sick during the cruise, report you illness to the staff and isolate yourself in your room

Recommendations For Food Handlers

  • Do not prepare food while you are sick.
  • Wash your hands carefully and frequently with soap and water.
  • Wash fruits and vegetables and cook shellfish thoroughly.
  • Clean and disinfect kitchen utensils, counters, and surfaces that may have norovirus on them.
  • Wash table linens, napkins, and other laundry thoroughly.[10]

Vessel Sanitation Program

The Vessel Sanitation Program (VSP) at the Centers for Disease Control and Prevention (CDC) assists the cruise ship industry to prevent and control the introduction, transmission, and spread of gastrointestinal (GI) illnesses on cruise ships. VSP operates under the authority of the Public Health Service Act (42 U.S.C. Section 264 Quarantine and Inspection Regulations to Control Communicable Diseases). Following steps are taken by VSP to prevent norovirus outbreaks on cruise ships:

  • Periodic unannounced and/or scheduled inspection of the cruise ships
  • Monitoring gastrointestinal illnesses and investigating or responding to outbreaks
  • Training cruise ship employees on public health practices
  • Providing reliable and current public health information to the health authorities, traveling population, cruise ship industry, public health professionals and the media


  4. Chadwick PR, Beards G, Brown D, Caul EO, Cheesbrough J, Clarke I, Curry A, O'Brien S, Quigley K, Sellwood J, Westmoreland D (2000). "Management of hospital outbreaks of gastro-enteritis due to small roundstructured viruses". J. Hosp. Infect. 45 (1): 1–10. doi:10.1053/jhin.2000.0662. PMID 10833336.
  7. EPA Registered Hospital Disinfectants Effective Against Norovirus (Norwalk-like virus)
  8. Shieh Y, Monroe SS, Fankhauser RL, Langlois GW, Burkhardt W, Baric RS (2000). "Detection of norwalk-like virus in shellfish implicated in illness". J. Infect. Dis. 181 (Suppl 2): S360–6. doi:10.1086/315578. PMID 10804149.
  9. Cruising Tips

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